Individual
ANSLEY WALLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSN, APRN, AGACNP-BC
Contact information
Practice address
2425 HIGHWAY 121 STE 201, BEDFORD, TX 76021-5011
(817) 283-5166
(817) 283-5176
Mailing address
3801 WILLIAM D TATE AVE STE 105, GRAPEVINE, TX 76051-8755
(817) 488-6812
(817) 251-1303
Taxonomy
Speciality
Code
Description
License number
State
163WG0600X
Gerontology Registered Nurse
Primary
1097452
TX
363L00000X
Nurse Practitioner
1097452
TX
Other
Enumeration date
09/01/2022
Last updated
01/11/2023
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